Relationship of the novel Left Ventricular–Arterial Coupling index to COVID-19 severity and all-cause mortality

Objective This study sought to investigate the prognostic impact of a novel ventricular-vascular coupling index, the arterial velocity pulse index (AVI) to left ventricular global circumferential strain (GCS) ratio (AVI/GCS) in patients with COVID-19. Methods 217 patients who were diagnosed with COVID-19 were retrospectively reviewed over a 2- month period, and were stratified into two groups (mild and moderate/severe). The traditional indexes (effective arterial elastance, Ea, left ventricular end-systolic elastance, Ees, and ventricular-vascular coupling index, VVI) and the novel indexes (AVI, GCS, AVI/GCS) were acquired. Receiver operating characteristic curve (ROC) analysis was used to compare the diagnostic efficacy of the two indexes and established the optimal cut point. Cox proportional hazard models were used to evaluate the associations with AVI/GCS and all-cause mortality. Result Among 217 patients analyzed, and 46.54% of the patients were male. The moderate/severe group showed higher values of VVI and lower AVI/GCS compared to mild group. The AVI/GCS [AUC 0.856, 95%CI 0.803-0.909] showed improvement in model discrimination compared with the other ventricular-arterial coupling indexes (Ea, Ees, VVI, AVI and GCS), with the cutoff value of -65.85. The AVI/GCS ratio <-65.85 vs >-65.85 was associated with an increased risk of all-cause mortality (HR: 4.801; 95% CI: 1.095-21.054). Conclusions AVI/GCS was more effective in detecting differences in cardiovascular function, and was a strong predictor of adverse outcomes in COVID-19 patients.